What's the Diagnosis? By Dr. Eric Chavis
72 yo M w/ PMHx of HTN, HLD, CKD (not on dialysis), DM and CAD presents to the ED with scrotal pain x 1 week. He is concerned that he has an "abcess" and wanted to be checked. A CT is done and shown below. What's the diagnosis? (scroll down for answer)
Answer: Fournier's Gangrene
- Note CT scan above showing scrotal edema with subcutanteous air
- Fournier's Gangrene is a form of necrotizing fasciitis of the perineal, perianal and genital regions
- Majority of cases affect males, but can occur in females
- Most common comorbid conditions: DM and ETOH use
- Exam may show cellulitis, crepitus, pain and skin necrosis
- Typically polymicrobial infection
- Early surgical debridement and antibiotics help limit mortality- but still as high as 20-30%
- Once suspected--- call your surgeon!
- Can get advanced imaging including CT scan if diagnosis not clear
- Start broad spectrum antibiotics- vancomycin and carbapenem or piperacillin-tazobactam +/- clindamycin or metronidazole
- Goal is to cover gram positive, gram negative, and anaerobes
- Don't forget blood cultures and fluid resuscitation!